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Annual Healthcare Insurance Review: Why It’s Essential

Missouri Health Insurance Agency for Simple Reliable and Direct Advisors

Before renewing your policy, you should perform an annual healthcare insurance review. Performed by both policy holders and members, this provides both parties with the opportunity to reflect on the coverage period and make any necessary adjustments. 

Although these reviews may seem trivial, there are several reasons why they’re essential. Specifically, reviews are necessary for ensuring that healthcare professionals and insurers meet your expectations and care needs. 

To help you learn more about annual healthcare insurance reviews, our experts at My Healthcare Direct have provided you with a simple guide. 

What is an Annual Healthcare Review?

An annual healthcare review refers to the yearly evaluation of your insurance policy to determine its efficacy. This allows either policyholders or members to assess healthcare needs or goals. 

image of a man providing an annual healthcare review

Types of Annual Healthcare Reviews

The following are several types of yearly reviews that occur in healthcare:

Self-Review

Members often conduct their own yearly reviews of their insurance policy. Namely, this allows them to review the coverage period, report any major life changes (i.e., income changes, divorce, or having a baby), and decide if they want to switch policies due to rising medical costs or different healthcare needs.

Physician’s Utilization Reviews

Utilization reviews are defined as evaluations, by a person or entity other than the patient’s health care provider, of the necessity, appropriateness, and efficacy of the use of health care services, procedures, and facilities to determine the medical necessity of the service, procedure, or facility admission.

Specifically, physician medical directors working for healthcare insurance companies conduct utilization reviews, participate in quality-of-care reviews, and adjudicate appeals.

In other words, they ensure proper care is administered, look for changes in clinical information to determine the appropriateness of treatment, and demonstrate proof of optimal care.

Member Surveys

Another means by which providers evaluate efficacy is through member surveys. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) asks health plan members to rate the care they have experienced with their health plan and its services. This gives patients the opportunity to give valuable feedback to providers and physicians. 

Reasons You Should Review Your Healthcare Annually

Although it’s beneficial for policyholders to perform yearly checks, taking the time to conduct your own review is essential for making sure your care matches your current needs. 

Before renewing your health insurance, here are several reasons you should review your policy annually:

Changes In Healthcare Needs

Each year, your healthcare needs may change. For example, you may develop a chronic condition that requires a new policy or an amendment to the pre-existing one. Since everyone experiences changes in their health condition, these reviews are necessary for obtaining the right care through your insurance company.

Lifestyle changes

Lifestyle changes are quite common. You might decide that you no longer want to pay for additional services and want to eliminate supplemental insurance, especially if the copays or premiums are high. Or you might have developed habits or ailments that increase your chances of getting sick, such as smoking or arthritis. 

In that case, you should take the time to think carefully about what insurance is most suitable. 

Major Life Events

When you experience major life events, the healthcare marketplace refers to them as qualifying life events

The four main types consist of:

  • Loss of health coverage
  • Changes in household (married or divorced, having a baby or adopting a child, and family death)
  • Changes In Residence
  • Other Significant Events (income changes, leaving incarceration, or becoming a U.S. citizen) 

Rate Increases

Rate Review helps protect you from unreasonable rate increases. Insurance companies must now publicly explain any rate increase of 15% or more before raising your premium. 

Appeals

If you disagree with certain decisions made regarding your healthcare, the annual review gives you the space to reflect and file an appeal with your insurance provider.

Contact My Healthcare Direct For Assistance With Annual Reviews

If you need advice regarding your annual healthcare insurance review, reach out to My Healthcare Direct. Navigating the marketplace can be stressful and overwhelming. 

However, our experts are dedicated and passionate about assisting you with all aspects of the healthcare marketplace. Instead of doing it alone, you’ll have our support and guidance.

Finally, we will make the insurance process easier for you! 
Please contact us today to speak with one of our health insurance experts!

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